title: Canadian Pain Society and Canadian Rheumatology Association recommendations for rational care of persons with fibromyalgia: a summary report.
abstract: OBJECTIVE
  To summarize the development of evidence-based guidelines for the clinical care of persons with fibromyalgia (FM), taking into account advances in understanding of the pathogenesis of FM, new diagnostic criteria, and new treatment options.
  
  
  METHODS
  Recommendations for diagnosis, treatment, and patient followup were drafted according to the classification system of the Oxford Centre for Evidence-Based Medicine, and following review were endorsed by the Canadian Rheumatology Association and the Canadian Pain Society.
  
  
  RESULTS
  FM is a polysymptomatic syndrome presenting a spectrum of severity, with a pivotal symptom of body pain. FM is a positive clinical diagnosis, not a diagnosis of exclusion, and not requiring specialist confirmation. There are no confirmatory laboratory tests, although some investigation may be indicated to exclude other conditions. Ideal care is in the primary care setting, incorporating nonpharmacologic and pharmacologic strategies in a multimodal approach with active patient participation. The treatment objective should be reduction of symptoms, but also improved function using a patient-tailored treatment approach that is symptom-based. Self-management strategies combining good lifestyle habits and fostering a strong locus of control are imperative. Medications afford only modest relief, with doses often lower than suggested, and drug combinations used according to clinical judgment. There is a need for continued reassessment of the risk-benefit ratio for any drug treatment. Outcome should be aimed toward functioning within a normal life pattern and any culture of disablement should be discouraged.
  
  
  CONCLUSIONS
  These guidelines should provide the health community with reassurance for the global care of patients with FM with the aim of improving patient outcome by reducing symptoms and maintaining function.
authors.affiliation: Division of Rheumatology, McGill University, Montreal, Quebec, Canada. mary-ann.fitzcharles@muhc.mcgill.ca
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Fitzcharles
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ste-Marie
authors.forename: Don L
authors.initials: DL
authors.lastname: Goldenberg
authors.forename: John X
authors.initials: JX
authors.lastname: Pereira
authors.forename: Susan
authors.initials: S
authors.lastname: Abbey
authors.forename: Manon
authors.initials: M
authors.lastname: Choinière
authors.forename: Gordon
authors.initials: G
authors.lastname: Ko
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Moulin
authors.forename: Pantelis
authors.initials: P
authors.lastname: Panopalis
authors.forename: Johanne
authors.initials: J
authors.lastname: Proulx
authors.forename: Yoram
authors.initials: Y
authors.lastname: Shir
mesh_terms: D002170:Canada; D005356:Fibromyalgia / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008019:Life Style; D010358:Patient Participation; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
keywords: CARE; FIBROMYALGIA